Anales de la RANM

180 A N A L E S R A N M R E V I S T A F U N D A D A E N 1 8 7 9 AN UNUSUAL CASE OF ACUTE ABDOMEN Anca Oprisan, et al. An RANM. 2021;138(02): 180 - 182 Abstract Postabortion ovarian vein septic thrombophlebitis is a very rare variety with high complication rates and it should be considered as a differential diagnosis for febrile abdominal pain syndrome in the post-abortion period. The contrast-enhanced CT or MRI have the highest sensitivity and specificity to diagnose the ovarian veins thrombi. The treatment it consists in a combination of anticoagulation therapy and antibiotics. In case that anticoagulation is contraindicated it´s recommended placing an inferior vena cava filter. Resumen La tromboflebitis de las venas ováricas es una variedad muy rara con altas tasas de complicaciones y que se debe plantear como diagnóstico diferencial ante un síndrome de dolor abdominal febril en el periodo posterior al aborto. La TC o RM con contraste intravenoso tienen la mayor sensibilidad y especificidad para diagnosticar los trombos de las venas ováricas. El tratamiento consiste en una combinación de terapia anticoa- gulante y antibióticos. En caso de que la anticoagulación esté contraindicada se recomienda colocar un filtro de vena cava inferior. Keywords: Ovarian veins; Postabortion; Ovarian veins thrombophlebitis; Postabortion ovarian vein thrombosis. Palabras clave: Venas ováricas; Postaborto; Tromboflebitis; Tromboflebitis de las venas ováricas; Trombosis de las venas ováricas postaborto. Autor para la correspondencia Anca Oprisan Servicio de Radiología. Área Clínica de Imagen Médica Hospital Universitario y Politécnico La Fe. Valencia C/ Pere Bonfill, 5, 3º piso, puerta 5 · 46008 Valencia Tlf.: +34 91 159 47 34 | E-Mail: oprisan.anca@gmail.com DOI: 10.32440/ar.2021.138.02. cc02 Enviado: 30.06.21 | Revisado: 16.07.21 | Aceptado: 28.07.21 C A S O C L Í N I C O Anca Oprisan 1 ; Macarena Barreda Solana 2 1 Servicio de Radiología. Área Clínica de Imagen Médica. Hospital Universitario y Politécnico La Fe. Valencia 2 Hospital Intermutual de Levante AN UNUSUAL C ASE OF ACUTE ABDOMEN: B I LATERAL OVAR I AN VE INS THROMBOPHLEB I T I S UN CASO INUSUAL DE ABDOMEN AGUDO: TROMBOFLEBITIS DE AMBAS VENAS OVÁRICAS Postabortion ovarian vein septic thrombophle- bitis is a cause of pathological puerperium, being an uncommon but serious condition (1,2). It is associ- ated with certain risk factors such as emergency cesarean section, prolonged labor, premature rupture of membranes, chorioamnionitis, pelvic inflammatory disease, secondary to gynecological surgery or malignant factors. Pathophysiologically the thrombosis is explained due to intimal damage of the pelvic veins caused by the spread of uterine infection, the pro-coagulant state of pregnancy and pelvic venous ectasia (3). All of this will predispose to the formation of septic thrombi (3). The right ovarian vein will be affected in 90% of the cases, since the retrograde venous reflux in the left ovarian vein during delivery protects it from bacterial dissemi- nation (3). The clinical scenario usually presents between the second to fifth day after delivery, with nonspecific symptoms (vomiting, nauseas, right or left lower quadrant abdominal pain, sepsis) and persistent fever that does not yield with antibiotics (1,2). 36-year-old woman hospitalized for late abortion (24 weeks of gestation) and chorioamnionitis, treated with antibiotics. She has a worsening left-sided lower abdominal pain. Physically, pelvic tenderness without peritonism or urinary complaints. Laboratory tests consistent with severe inflammatory state including leukocytosis (17.000 cells/mmc) and elevated C-reactive protein (326 mg/L). After 48 hours of treatment, she persists with fever and worsening of her general condition. An abdominal ultrasound is performed without significant findings. Given the bad evolution of the patient a CT is requested. In the contrast enhanced CT (portal venous phase), a postpartum uterus is observed, with the presence of hypodense material occupying and distending CLINICAL CASE INTRODUC TION IMAGING FINDINGS